| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,686 |
5,547 |
$127K |
| D1120 |
Prophylaxis - child |
4,403 |
4,265 |
$114K |
| D1206 |
Topical application of fluoride varnish |
2,701 |
2,609 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,258 |
1,219 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
412 |
169 |
$21K |
| D1110 |
Prophylaxis - adult |
481 |
474 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,034 |
964 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
37 |
$3K |
| D1351 |
Sealant - per tooth |
39 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
63 |
$612.61 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
16 |
$407.55 |